By Heidi Cross, MSN, RN, FNP-BC, CWON

"Defendants failed to provide adequate nutrition to prevent plaintiff from suffering severe malnutrition and weight loss. This allowed the development of a severe pressure ulcer, numerous infections, and dehydration and malnutrition. Had defendants provided proper care, the pressure ulcer, infections, and malnutrition and dehydration would not have occurred."

By Temple University School of Podiatric Medicine Journal Review Club

An appropriate timeline to initiate biofilm-based wound care (BBWC) has been a topic of question since the incorporation of biofilm therapy was introduced. In hard-to-heal delayed wounds, it is largely agreed upon that biofilms are a significant barrier to healing, and that removal is essential. By definition, hard-to-heal wounds are wounds that have failed to respond to evidence-based standard of care and contain biofilm. Biofilms are polymicrobial communities residing in an extracellular matrix produced by bacteria, which is well-hydrated and resistant against antimicrobial agents and host defenses. Biofilm can form within hours, can reach maturity within 48-72 hours, and has the ability to regrow within 24-48 hours. A first critical step to BBWC is debridement, though it requires additional suppression methods, as well as considerations of a patient’s risk factors. Risk factors include peripheral vascular disease, infection, diabetes, and pressure off-loading, which encourage biofilm development by delaying wound healing. Risks and costs with early BBWC are most likely less than those associated with biofilm-related wound complications. Thus, in March 2019, a panel of nine experts met in London for an Advisory Board Meeting, where they developed solutions to barriers preventing early BBWC and methods of appropriate “wound hygiene” for all health professionals. They reconvened in the summer of 2019 to create a clinical consensus document published in the Journal of Wound Care supported by ConvaTec Limited.

Paula Erwin-Toth, RN, MSN, FAAN

Hello to my wound care colleagues around the world. As I write this blog, the news relating to the results of COVID-19 continues to provide evidence of the profound impact this pandemic has had on those suffering from the disease and the negative impact shut downs and quarantines have had on the health of people with chronic illnesses. We, as health care providers, are under tremendous stress as many of us have been re-deployed to maintain and support the overwhelming challenges of front-line health care providers serving patients with COVID-19. We, too, are on the front lines helping to maintain skin integrity in critically ill patients who are often intubated and placed in the prone position. The physical, emotional, and financial strains on patients, health care providers, businesses, and governments are going to affect us for years to come.

By Temple University School of Podiatric Medicine Journal Review Club

Venous leg ulcerations (VLUs) are a common and often chronic pathology, and these wounds diminish the quality of life and increase the financial burden for affected patients. A recent article estimates that up to 3% of the U.S. population suffer from VLUs. A venous leg ulcer can be severely painful and may decrease a patient’s quality of life by affecting sleep, mobility, activities of daily living, and even result in social isolation. A 1994 paper proposed that approximately 65% of patients felt financially affected by a VLU, and this number is likely to have increased as a result of rising healthcare costs. The prevalence and chronic nature of the venous leg ulceration has motivated physicians to research novel techniques to heal ulcers successfully and in a timely manner.
Acellular dermal matrices have been utilized to treat diabetic foot ulcers with favorable outcomes.4 This study investigated the efficacy of a specific acellular dermal matrix for VLUs.